doi: 10.1161/01.CIR.0000115310.36419.9E
(Circulation. 2004;109:587-593.)
© 2004 American Heart Association, Inc.
Clinical Investigation and Reports |
High Rates of Sustained Smoking Cessation in Women Hospitalized With Cardiovascular Disease
The Women’s Initiative for Nonsmoking (WINS)
From the University of California at San Francisco, Department of Physiological Nursing, School of Nursing (E.S.S.F., D.J.C., K.M., K.M.P., M.A., Z.L., M.S.), Department of Epidemiology & Biostatistics, School of Medicine (E.S.S.F., P.B.), and Departments of Medicine, Psychiatry, and Biopharmaceutical Sciences (N.B.), San Francisco, Calif; Stanford University, Cardiac Rehabilitation Program (N.H.M.) and Department of Psychiatry and Behavioral Sciences (C.B.T.), School of Medicine, Palo Alto, Calif; and San Francisco General Hospital Medical Center, Division of Clinical Pharmacology and Experimental Therapeutics, Medical Services (N.B.), San Francisco, Calif.
Reprint requests to Erika S. Froelicher, RN, PhD, Professor, Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way, Room N631, Box 0610, San Francisco, CA 94143-0610. E-mail erika.froelicher{at}nursing.ucsf.edu
Received December 1, 2003; accepted December 9, 2003.
Background— Although men hospitalized with cardiovascular disease (CVD) show high smoking-cessation rates, similar data for women are lacking. We tested the efficacy of smoking-cessation intervention in women hospitalized for CVD.
Methods and Results— In this randomized controlled trial conducted from 1996 to 2001, 277 women diagnosed with CVD (mean age 61±10 years) were randomly assigned within 1 of 12 San Francisco Bay Area hospitals to a usual-care group (UG; n=135) or intervention group (IG; n=142). Baseline histories were obtained, and interviews to ascertain self-reported smoking status occurred at 6, 12, 24, and 30 months after hospitalization. The UG received strong physician’s advice, a self-help pamphlet, and a list of community resources. The IG received strong physician’s advice and a nurse-managed cognitive behavioral relapse-prevention intervention at bedside, with telephone contact at intervals after discharge. The groups were similar demographically and had smoked cigarettes for a median of 38 (IG) or 40 (UG) years. Time to resumption of continuous smoking was assessed by Kaplan-Meier analysis, and risk differences between groups were determined. Time smoke-free was significantly greater for the IG than the UG (P=0.038). Point prevalence for nonsmoking at the interviews was somewhat greater for the IG than the UG (P>0.15 at all times).
Conclusions— Cognitive behavioral intervention resulted in longer average times to resumption of smoking, but in these 2 groups of older women with limited social and financial resources, long-term success rates were similar. Systematic identification of smokers and even the brief intervention afforded the UG yielded a high smoking-cessation rate over time.
Key Words: smoking • women • sex • cardiovascular diseases
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